Registration

Registration for Summer 2021

* Indicates required field

Parents Name: *

Parents Name 2 *

Address *

Emergency Contact Number *

Parents Cell *

Parents Cell (2) *

Parents Email *

Parents Email (2) *

Dates Swimmer is NOT Available *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/21 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/21 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/21 *

Medical Release Information:

Primary Medical Insurance Name: *

Policy Number: *

Preferred Hospital: *

Known Allergies or Other Pertinent Medical Information: *

DEADLINE FOR REGISTRATION IS MAY 24, 2021.

SWIMMERS WILL BE IN THE POOL BEGINNING JUNE 1,2021. PRACTICE SCHEDULES WILL BE PROVIDED ONCE REGISTRATION IS COMPLETE. TENTATIVELY, HIGH SCHOOL AND INVITED MIDDLE SCHOOL SWIMMERS WILL HAVE PRACTICE IN THE MORNING. OTHER SWIMMERS WILL PRACTICE AFTER 6:00PM.

REGISTRATION FEE IS $230 PER SWIMMER. PLEASE MAKE CHECKS PAYABLE TO:
TROJAN AQUATIC CLUB
C/O R. SCARPATO
1109 SMALLBROOK LANE
YORK, PA 17403

By submitting this form, I give my permission for my child to participate in the Trojan Aquatic Club. I will not hold the aquatic club, York Suburban School District or the coaching staff responsible for any injury while participating in the program. I also give permission for my child to be treated by emergency personnel in the event of an injury if I am not present.

Submit

signature forms